Does age affect the outcomes and management of pediatric appendicitis in Taiwan?

Background The comprehensive coverage offered by the Taiwan National Health Insurance program enabled us to effectively evaluate the effect of age on postoperative morbidity. Purposes To investigate whether age affected the outcomes and management of appendicitis in children in Taiwan. Methods We use the Collaboration Center for Health Information Application database to identify 21,827 patients ≤18 years of age with a diagnosis of acute appendicitis between 2007 and 2012 in Taiwan. Study outcomes included postoperative morbidity, undergoing laparoscopic appendectomy (LA) or open appendectomy (OA), and the length of hospitalization. Postoperative morbidity included the incidence of intra-abdominal abscesses (IAAs) and postoperative bowel obstructions (PBOs). Patients were divided into: ≤6, 7–12, and 13–18 years. Data were calculated using Chi-squared test and multivariate logistic regression models. Results The perforation rate was highest for patients ≤6 years old and also an LA was least often performed in younger children compared with those aged 7–12 years 13–18 years; (p < 0.0001). In the multivariable analysis, the ORs for IAAs and PBOs for patients aged 7–12 and 13–18 years who had a perforated appendicitis and underwent an LA were (0.66; p = 0.0182), (0.51; p = 0.0001); and (0.49; p = 0.0125), (0.41; p = 0.0014), respectively, compared with those aged ≤6 years. Our study demonstrates that children in the (≤6 years) age group had a high rate of appendix perforation and required fewer LAs; when LAs were performed on children in this age group to treat perforated appendicitis, IAA and PBO risks were higher than other older age groups.